The Centers for Medicare & Medicaid Services (CMS) recently issued Conditions of Participation requiring the reporting of COVID-19 related information by hospitals and critical access hospitals for tracking the incidence and impact of COVID–19.  On October 6, CMS released interpretive guidance on the Conditions of Participation, detailing the numerous reporting requirements for hospitals.  Hospitals are required to report many data points daily, such as hospital bed capacity, ventilator capacity, and hospital admissions.  Hospitals are also required to report on personal protective equipment (PPE) supplies weekly.  CMS is making influenza data reporting optional starting October 19, with the intention of having this requirement become mandatory in the coming weeks.

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On Tuesday, July 28, CMS updated the COVID-19 Frequently Asked Questions (FAQs) on Medicare Fee-for-Service (FFS) Billing to provide guidance on billing HCPCS code G0463 when a physician is providing a remote service to a patient in the patient’s home, which has been designated as a provider-based department.  As we noted last week (see our memorandum of July 22), CMS has taken inconsistent positions on this issue in its Office Hours calls—first stating that billing a G0463 is not permitted, then stating that it is, and then reversing course again to prohibit it.  In its first official written guidance on the subject, CMS changed course once again.

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Click here for a PDF version of this memo.

On Tuesday, July 21, in a CMS “Office Hours” COVID-19 call, CMS provided the latest guidance on billing HCPCS code G0463 when a physician is providing a telehealth service to a patient in the patient’s home, which has been designated as a provider-based department.  The guidance represents a departure from previous oral advice provided by CMS and is the latest twist in a confusing mix of written guidance and oral advice on the subject of how hospitals should bill for these visits.

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By Rebecca Burke, Esq. and Megan La Suer, Esq

Current as of June 1, 2020

Click here to download a PDF of this article.

Over the last several weeks, Powers has been reporting on the telehealth expansion during the COVID-19 pandemic. (More information is  available on the Powers website.) The Coronavirus Aid, Relief, and Economic Security Act (CARES Act), enacted on March 27, 2020 and the Centers for Medicare and Medicaid Services (CMS) Interim Final Rule (IFR), issued on March 31, both contain significant telehealth provisions. CMS has also been issuing a steady stream of guidance regarding implementation of these provisions, although many questions still remain unanswered. On April 30, 2020 CMS issued a new series of updates including new waivers and a new IFR. This series of Q & As address many of the temporary telehealth provisions that apply during the COVID-19 public health emergency (PHE) including the April 30, 2020 announcements. Powers will be updating this document as the Administration continues to issue additional guidance.  The information contained in this document shall not be considered legal advice but should be instructive for providers seeking to be in compliance with laws, regulations, and guidance that are being issued and changed frequently.

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Updated May 12, 2020

In an Interim Final Rule published on March 31, CMS authorized physicians to bill for telehealth visits as if they were office visits in response to the COVID-19 public health emergency (“PHE”).  Since then, many hospitals have pointed out that there was no mechanism for a hospital to bill an originating facility fee for a telehealth service performed by a physician from a hospital outpatient department or other provider-based clinic.  Consequently, these services were reimbursed less when performed from a hospital site, as compared to a physician office site.  (The UB92 hospital outpatient billing form does not provide for billing of a telehealth originating site facility fee because the patient is not physically present at the hospital.) This issue was raised repeatedly by providers during the CMS “Office Hours” teleconferences, during which CMS acknowledged the inconsistency and promised to release additional guidance.

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